Hospital management critics claim that both cost and quality of care could be improved were it not for management ineffectiveness and inefficiency. Hospital management consolidation is considered to be one of the remedies that encourages efficiency; however, there is public concern about the operation of these groups. The literature contains mostly subjective editorial judgments and non-empirical contributions, producing contradictory conclusions with no objective or comprehensive studies to support claims and counter claims made. This study proposes a model for systematically analyzing multi-hospital organizational management and performance to clarify some of the above. OBJECTIVES: 1) Compare management practices (19 variables) of multi-hospital management structure at hospital and headquarters levels. 2) Examine the impact of contextual factors (9 variables) to determine if they influence organization structure management. 3) Compare patient care (9 variables) and administrative (10 variables) effectiveness of hospital performance. 4) Determine degree of differences in effectiveness caused by environmental factors on management practices and their relation to performance. 5) Compare proprietary vs. voluntary on the above four areas 6) Compare the two for availability of "non-profitable" services. 7) Compare distribution of hospitals in rural and urban areas. 8) Propose classification scheme for multi-hospital management practice. METHODOLOGY: 1) Selection of a national stratified multi-hospital sample. 2) Use secondary data sources like American Hospital Association, Federation of American Hospitals, and Catholic Hospital Assoc. 1977 Guides, U.S. Census, etc. 3) Prepare, pre-test, and distribute standardized questionnaires for hospital administrators and key corporation representatives. 4) Analyze data received. 5) Use regression correlation and factor analysis to meet objectives of the study by reducing multifactor and multiple variables to appropriate scales, and testing for significance among and with multi-hospital systems.